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General NPI Number Information
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NPI Number | 1316186893
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Entity Type | Organization
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Legal Business Name | FLAGLER DIAGNOSTIC AND SLEEPING DISORDER, INC.
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 1001 W. CYPRESS CREEK RD SUITE 104
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City | FT. LAUDERDALE
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State | FL
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Zip | 33309
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Country | US
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Telephone | 954-306-3760
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Fax | 877-537-8123
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Provider Business Mailing Address
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Address Line | 4721 E. MOODY BLVD SUITE 104
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City | BUNNELL
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State | FL
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Zip | 32110
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Country | US
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Telephone | 386-586-6229
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Fax | 386-263-2975
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Authorized Official
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Title or Position | FACILITY DIRECTOR OFFICE MANAGER
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Name | MS. KIMBERLY LYNN ROCHES
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Credential | CFE, BS, AA
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Telephone | 386-586-6229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | HCC8433
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License Number State | FL
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